Ministry of Health, Jalan Bangsar, 50590 Kuala Lumpur...

iCentre for Burden of Disease Research, Institute for Public Health

MALAYSIANBURDEN OFDISEASE AND INJURY StUDY2009 - 2014

Centre for Burden of Disease Research

Institute for Public Health

National Institutes of Health

Ministry of Health, Malaysia

2017

ii Malaysian Burden Of Disease And Injury Study 2009 – 2014

Editors:Dr Mohd Azahadi Omar, Dr Shubash Shander Ganapathy, Mohamad Fuad Mohamad Anuar,Dr Chandrika Jeevananthan, Dr Fazila Haryati Ahmad, Dr LeeAnn Tan, Nazirah Alias

Produced and distributed by:Centre for Burden of Disease Research,Institute for Public Health, National Institutes of Health,Ministry of Health,Jalan Bangsar, 50590 Kuala Lumpur,MalaysiaTel : +603- 2297 9400Fax : +603- 2282 3114

Any enquires or comments on this report should be directed to:

Principal Investigator,Malaysian Burden of Disease and Injury Study,Institute for Public Health, National Institutes of Health,Ministry of Health,Jalan Bangsar, 50590 Kuala Lumpur,MalaysiaTel : +603- 2297 9400Fax : +603- 2282 3114

Published by Institute for Public Health, National Institutes of Health, Ministry of Health.

@2017, Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur.

ISBN: 978-983-2387-42-8

Suggested Citation:Institute for Public Health (IPH) 2017. Malaysian Burden of Disease and Injury Study 2009- 2014

Disclaimer:The views expressed in this report are those of the authors alone and do not necessarily represent the opinions of the other investigators participating in the surveys, nor the view or policy of the Ministry of Health Malaysia.

iiiCentre for Burden of Disease Research, Institute for Public Health

The authors would like to thank the Director of the Institute for Public Health Malaysia for his continuous advice, guidance and support throughout the study. This study on Malaysian Burden of Disease and Injury was conducted with funding from the Ministry of Health, Malaysia and the authors would like to express their gratitude to the Ministry for the financial support.

Furthermore, we would like to thank the Disease Control Division and Health Information Centre of Ministry of Health, Malaysia for providing the extensive input and data that made this analysis possible. Our utmost appreciation also goes to the Department of Statistics Malaysia for their assistance not only in preparing and providing the data as needed, but also for their cooperation in working together with our team during the course of this study.

We would also like to thank the WHO representative officer for Malaysia for their assistance in providing financial support towards consultancy services. Our sincere gratitude to Dr Chalapati Rao, from Department of Global Health, Research School of Population Health, Australian National University, Australia for assisting us and providing invaluable advice and technical input and guidance for this study.

This study is based on the methodologies and in many areas, the inputs and estimates derived from the Institute of Health Metrics and Evaluation, University of Washington, which we gratefully acknowledge.

We would like to express our gratitude to all co-authors (staff from the Centre for Burden of Disease Research, Institute for Public Health) for all their assistance and excellent teamwork rendered in facilitating the production of this Malaysian Burden of Disease and Injury Study report. Finally, we thank the Director General of Health, Malaysia for permission to publish this report.

Thank you!

Acknowledgement

iv Malaysian Burden Of Disease And Injury Study 2009 – 2014

Preface

Disease burden measures burden of disease using Disability Adjusted Life Years (DALYs). This time-based measure combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health.

This report provides a comprehensive result of the Malaysian Burden of Diseases and Injuries study. Our intention is to give a comprehensive overview of our approaches, results and some discussion on the results, suggestions and recommendations from the study for future planning in Ministry of Health Malaysia (MOH) especially in strengthening local data sources. Despite the complexity in the burden of disease methodology, in addition to limitations of quality data sources, we were still able to produce reasonable results, which can be used to guide the planning of programmes by the Ministry of Health Malaysia.

Much effort was taken to improve the quality of data sources and hence the study itself. Hopefully, this report can be used as a powerful reference for future work to help in improving local data sources and to produce some valuable information for the Ministry of Health to use in policy-making efforts and planning. The Centre for Burden of Disease Research is ever-ready to collaborate with other organizations within the Ministry of Health in striving to produce the most accurate and comprehensive estimates of diseases burden in Malaysia.

In future, we hope to estimate the burden of disease attributable to various risk factors and produce projections of diseases burden in Malaysian for the next 10 years. It is hoped that this study provides the foundation and framework on which debates on national health priority setting can be based.

vCentre for Burden of Disease Research, Institute for Public Health

Figure 2.1 Components of Disability-Adjusted Life Years (DALYs)

Figure 3.1.1 Percentage (%) of deaths, by disease groups and sex, 2009

Figure 3.1.2 Number (a) & percentage (b) of deaths, by disease groups & age, males, 2009

Figure 3.1.3 Number (a) & percentage (b) of deaths, by disease groups & age, females, 2009

Figure 3.1.4 Leading causes of death (death ‘000; percentage %) for males, by age group, 2009

Figure 3.1.5 Leading causes of death (death ‘000; percentage %) for females, by age group, 2009


























Figure 4.1.1 Percentage (%) of fatal burden (YLL), by disease groups and sex, 2009

Figure 4.1.2 Number (a) & percentage (b) of fatal burden (YLL), by disease groups & age, males, 2009

Figure 4.1.3 Number (a) & percentage (b) of fatal burden (YLL), by disease groups & age, females, 2009

Figure 4.1.4 Leading causes of fatal burden (YLL ‘000; percentage %) for males, by age group, 2009

Figure 4.1.5 Leading causes of fatal burden (YLL ‘000; percentage %) for females, by age group, 2009






List of Figures

vi Malaysian Burden Of Disease And Injury Study 2009 – 2014





















Figure 5.1.1 Percentage (%) of non-fatal burden (YLD), by disease groups and sex, 2009

Figure 5.1.2 Number (a) & percentage (b) of non-fatal burden (YLD), by disease groups & age, males, 2009

Figure 5.1.3 Number (a) & percentage (b) of non-fatal burden (YLD), by disease groups & age, females, 2009

Figure 5.1.4 Leading causes of non-fatal burden (YLD ‘000; percentage %) for males, by age group, 2009

Figure 5.1.5 Leading causes of non-fatal burden (YLD ‘000; percentage %) for females, by age group, 2009






















viiCentre for Burden of Disease Research, Institute for Public Health





Figure 6.1.1 Percentage (%) of DALYs by YLL vs YLD for males and females, by disease group, 2009

Figure 6.1.2 Percentage (%) of total burden (DALYs), by disease groups and sex, 2009

Figure 6.1.3 Number (a) & percentage (b) of total burden (DALYs), by disease groups & age, males, 2009

Figure 6.1.4 Number (a) & percentage (b) of total burden (DALYs), by disease groups & age, females, 2009

Figure 6.1.5 Leading causes of total burden (DALYs ‘000; percentage %) for males, by age group, 2009

Figure 6.1.6 Leading causes of total burden (DALYs ‘000; percentage %) for females, by age group, 2009































viii Malaysian Burden Of Disease And Injury Study 2009 – 2014

Table 2.1 Garbage code redistribution

Table 3.1.1 Death by disease groups and sex, 2009

Table 3.1.2 Leading causes of deaths, by sex, 2009











Table 4.1.1 Fatal burden of disease and injury by disease group and by sex, 2009

Table 4.1.2 Leading causes of fatal burden (YLL), by sex, 2009











Table 5.1.1 Non-fatal burden of disease and injury by disease groups and by sex, 2009

Table 5.1.2 Leading causes of non-fatal burden (YLD), by sex, 2009







List of Tables

ixCentre for Burden of Disease Research, Institute for Public Health





Table 6.1.1 Total burden of disease and injury (DALYs) by disease groups and by sex, 2009

Table 6.1.2 Leading causes of total burden (DALYs), by sex, 2009











x Malaysian Burden Of Disease And Injury Study 2009 – 2014

xiCentre for Burden of Disease Research, Institute for Public Health

Acknowledgement iii Preface ivList of Figures vList of Tables viiiTable of Contents xiExecutive Summary xii

1.0 INTRODUCTION 12.0 METHODOLOGY 23.0 DEATHS 11

3.1 Deaths – 2009 123.2 Deaths – 2010 203.3 Deaths – 2011 283.4 Deaths – 2012 363.5 Deaths – 2013 443.6 Deaths – 2014 52

4.0 YEARS OF LIFE LOST (YLL) 614.1 Years of Life Lost (YLL) – 2009 624.2 Years of Life Lost (YLL) – 2010 704.3 Years of Life Lost (YLL) – 2011 784.4 Years of Life Lost (YLL) – 2012 86 4.5 Years of Life Lost (YLL) – 2013 944.6 Years of Life Lost (YLL) – 2014 102

5.0 YEARS LOST DUE TO DISABILITY (YLD) 1115.1 Years Lost due to Disability (YLD) – 2009 1125.2 Years Lost due to Disability (YLD) – 2010 1205.3 Years Lost due to Disability (YLD) – 2011 1285.4 Years Lost due to Disability (YLD) – 2012 1365.5 Years Lost due to Disability (YLD) – 2013 1445.6 Years Lost due to Disability (YLD) – 2014 152

6.0 DISABILITY-ADJUSTED LIFE YEARS (DALYS) 1616.1 Disability-Adjusted Life Years (DALYs) – 2009 1626.2 Disability-Adjusted Life Years (DALYs) – 2010 1716.3 Disability-Adjusted Life Years (DALYs) – 2011 1806.4 Disability-Adjusted Life Years (DALYs) – 2012 1896.5 Disability-Adjusted Life Years (DALYs) – 2013 1986.6 Disability-Adjusted Life Years (DALYs) – 2014 207

7.0 DISCUSSION 217APPENDIX 221REFERENCES 239

Table of Contents

xii Malaysian Burden Of Disease And Injury Study 2009 – 2014

Developed by the Global Burden of Disease (GBD) study, Burden of Disease is a summary measure of population health. The overall burden of disease, measured in DALY, combines the potential Years of Life Lost (YLL) due to premature death and the Years Lost due to Disability (YLD), an equivalent of potential healthy years lost due to poor health, illness or disability.

Between 2009 and 2014, Cardiovascular and Circulatory Diseases, Malignant Neoplasms, Respiratory Infections, Unintentional Injuries and Respiratory Diseases make up the top 5 leading mortality causing disease categories in Malaysia. Among males, Ischaemic Heart Disease caused the highest number of deaths, followed by Cerebrovascular Diseases and Road Traffic Injuries. Cerebrovascular Diseases caused the highest number of deaths in females, followed by Ischaemic Heart Disease and Lower Respiratory Infections.

Cardiovascular and Circulatory Diseases, Malignant Neoplasms, Unintentional Injuries and Respiratory Infections contributed towards the leading causes of fatal burden of disease and injury in Malaysia between 2009 and 2014. Road Traffic Accidents contributed towards the leading cause of fatal burden among males, followed by Ischaemic Heart Disease and Cerebrovascular Diseases. Among females, Cerebrovascular Diseases were the leading cause of fatal burden followed by Ischaemic Heart Disease and Lower Respiratory Infections.

Non-fatal burden of disease and injury in Malaysia between 2009 and 2014 is mainly contributed by Mental and Behavioural Disorders, Diabetes Mellitus, Respiratory Diseases, Neurological Conditions and Cardiovascular and Circulatory Diseases. Among both males and females, Diabetes Mellitus was the leading cause of non-fatal burden. Ischaemic Heart Disease and Asthma were among the highest causes of non-fatal burden among males with Anxiety Disorder and Asthma the other leading causes among females.

Cardiovascular and Circulatory Diseases, Unintentional Injuries and followed by Malignant Neoplasms caused the highest total burden of disease and injury in Malaysia between 2009 and 2014. Road Traffic Injuries, Ischaemic Heart Disease, Cerebrovascular Diseases and Diabetes Mellitus caused the highest burden among males, with Cerebrovascular Diseases, Diabetes Mellitus, Ischaemic Heart Disease and Lower Respiratory Infections being the leading cause of total disease burden among females.

Burden of Disease study uses a macro level approach towards determining the burden of each disease, measuring the burden of diseases and injuries for a population at whole. The estimates presented in this study, though limited by availability of certain data, was derived from best available local data for Malaysia and through critical appraisal of available information. We believe that the estimates produced in this study is the most accurate representation of cause of death and disease burden in Malaysia.

Executive Summary

1Centre for Burden of Disease Research, Institute for Public Health

1.0 IntroductionDeveloped by the Global Burden of Disease (GBD) study, Burden of Disease is a summary measure of population health. Burden of Disease study is the most recognized and widely regarded as the best summary measure that combines the impact of fatal and non-fatal conditions. The burden of specific disease conditions and overall loss of health is measured by quantifying the difference between living to old age in good health, and any deviation from a healthy state, may it be due to illness, injury, disability or death.

The overall burden of disease, measured in DALY, combines the potential years of life lost (YLL) due to premature death and the years lost due to disability (YLD), an equivalent of potential healthy years lost due to poor health, illness or disability. It other words, DALY combines the impact of dying early and living with an illness. The health loss is thus a comparison against an ideal situation where everyone lives to their potential life expectancy, free of any disease or disability.

This report presents the findings of the third Malaysian Burden of Disease (MBOD) Study, the first being done in the year 2000, followed by a second study in the year 2008. A comprehensive assessment of the magnitude and distribution of disease conditions from 2009 to 2014, for more than 100 disease conditions, is summarized in this report. The MBOD study was carried out to assist stakeholders in the public health, health services and medical research in setting priorities and planning of services and resources.

ReferencesMurray, C. J. (1994). Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bulletin of the World Health Organization, 72(3), 429.WHO (2013). WHO methods and data sources for global burden of disease estimates 2000-2011. Geneva: Department of Health Statistics and Information Systems.

2 Malaysian Burden Of Disease And Injury Study 2009 – 2014

The disease and injury categories are a specific list of diseases and causes of injury for which the estimates are calculated. The categories are mutually exclusive and collectively represents all the diseases and causes of injuries. The list was drawn up to cover all fatal and non-fatal health outcomes, with the final decision on the diseases and injuries to be included in the list based on health priorities of the diseases, the availability of data, and policy interest relevant to Malaysia.

Since the last Malaysian Burden of Disease (MBOD) Study in 2008, the Global Burden of Disease (GBD) Study has undergone many revisions and updates. A team of experts from Institute for Public Health, Malaysia was set up to review and formulate a relevant and updated list for the MBOD estimates for this study. The previous disease categories used in the MBOD 2008 study, World Health Organization (WHO) Mortality Tabulation and GBD 2015 list were used for comparison to determine the current disease and injury categories.

2.1DISEASE AND

INJURY CATEGORY

LIST

2.0Methods



2.2YEARS OF LIFE

LOST

2.2.1Mortality Data Source

A final disease and injury list consisting of 22 disease groups, under which 112 disease and injury categories were classified, was formulated. Residual causes were included in each disease group to ensure health loss was captured for all conditions. The final disease groups and categories used in this MBOD is included in Appendix I. The ICD-10 codes corresponding with each disease and injury category, as well as the disease group, are included.

Years of Life Lost (YLL) represents the burden of fatal diseases and injuries. Mortality data, by age and sex, was used to determine the YLL for each disease and injury category.

The YLL estimate takes into account all the deaths that occurred in the population during the time period of this study. The total number of deaths from all causes was obtained from the Department of Statistics Malaysia, the official source of national statistics in the country. Data for each year was obtained for the age at death, gender, and cause of death with its corresponding ICD-10 code.

Malaysian mortality data is collected through the vital registration system by the National Registration Department (NRD). The compiled data is subsequently sent to the Department of Statistics Malaysia, which assigns ICD-10 codes to the registered causes of deaths and produces the national annual vital registration statistics.

There are currently two systems for certification of deaths practiced in Malaysia:

• Medically certified deaths: Deaths that occur in health facilities and are certified as to cause of death by the attending physician

• Non-medicallycertifieddeaths: Deaths that occur outside health facilities and are reported to the local police station by the next of kin, who also provide a “lay” opinion of the cause of death


2.2.2.1 MissingData

The number of deaths with missing age or gender were extremely low. Missing values were assigned to the most prevalent age group or gender for the cause of death. Gross errors in the mortality data were also identified and corrected similarly by carrying out age-specific diseases check and sex-specific diseases check prior to redistribution.

2.2.2.2 GarbageCodes

The assigned cause of deaths may represent causes of death that do not accurately present the underlying cause of death. These inappropriate ICD codes for mortality, collectively known as “garbage codes”, compromise the usefulness of cause of death information from a policy perspective. These causes of death coded were listed as garbage codes if they represent;

• Causes that are not underlying cause or unlikely as a cause of death

• Intermediate causes of death• Immediate causes of death• Ill-defined or unspecified cause of death

Taking into consideration that Malaysia uses 3-character ICD-10 coding for causes of death and local practices of cause of death assignment, the team of Burden of Disease experts undertook to analyze the garbage codes listed by World Health Organization and Global Burden of Disease study. The ill-defined causes were then either:

a) allotted to specific cause categories; b) distributed within specific disease groups; or c) distributed to all causes

2.2.2Redistribution

methods


The final redistribution of the garbage codes is summarized in Table 2.1.

Specific Cause Allotment

Other Infectious Diseases A28, A48-A49, B82-B83, B94-B96, B99

Other Neonatal Conditions P28, P96

Other Nutritional Disorders E64

Mouth and Oropharynx Cancers C14

Trachea, Bronchus and Lung Cancers C39

Other Malignant Neoplasms C26, C55, C57, C63, C68, C75-C76, C97

Benign Neoplasms D09, D37-D41, D48

Diabetes mellitus E14

Endocrine, Blood and Immune Disorders E68, E85-E88

Other Neurological Conditions G09, G80-G83, G91-G93

Cerebrovascular Diseases (Stroke) I69

Other Circulatory Diseases I27, I31, I44-I45, I47, I49-I51, I74, I81, I99

Other Respiratory Diseases J80-J81, J86-J90, J93-J94, J98

Other Digestive Diseases I85, K65-K66, K71-K72, K75, K92

Nephritis and Nephrosis N18-N19

Other Musculoskeletal Diseases M86

Other Chromosomal Disorders Q99

Other Congenital Anomalies Q89

Road Traffic Injuries V99, Y85-Y86

Other Unintentional Injuries X59

Disease Category Redistribution

Redistribute to STDs excluding HIV A64

Redistribute to all Mental and Behavioural Disorders (GROUP J)

F99

Redistribute to all Neonatal Conditions (GROUP D) P95

Redistributed to all cancers (GROUP F) C80

Redistribute to circulatory causes (GROUP M) I10, I15, I70

All Cause Redistribution

Redistribute to all causes (GROUP I & II) A40-A41, D65, I26, I46, J96, N17, R00-R99

Redistribute to all causes (GROUP III) S00-T98, Y10-Y34, Y87, Y89

Table 2.1: Garbage Codes Redistribution


We found that garbage codes for redistribution represented 17.1% to 18.4% of medically certified deaths in Malaysia between 2009 and 2014. Specific cause allotment was assigned to the corresponding group and disease group redistribution was carried out pro-rata within their specific groups.

2.2.2.3 CauseSpecificMortalityFractions

A further challenge in accurate estimation of mortality in Malaysia is the presence of a little less than 50% of deaths that were not medically certified. To improve the quality of mortality data, based on the findings of a previous Malaysian nationwide study, we applied cause specific mortality fractions on the medically and non-medically certified deaths, derived by medical records review and verbal autopsy methods respectively, on the mortality data. This was able to give more accurate estimations of mortality numbers and significantly reduced the number of ill-defined cause of deaths for all-cause redistribution. The final ill-defined cause of deaths was than redistributed pro-rata either to all disease categories with Group I and II, or to Group III for ill-defined injury causes.

Years of Life Lost (YLL) was calculated by summing the number of deaths for the disease category at 5-year age intervals, multiplied by the remaining life expectancy for the specific age group. Life expectancy for each of the years calculated was used and was obtained from the published figures from the Department of Statistics Malaysia.

2.2.3Calculating Years of

Life Lost

YLL N LEYEARS OF LIFE LOST = xNUMBER OF DEATHS LIFE EXPECTANCY


2.3YEARS LOST DUE

TO DISABILITY

Years Lost due to Disability (YLD) represents the non-fatal diseases and injuries. Prevalence estimates for each disease and injury, including breakdown of the severity proportion and percentage contributing to its sequelae, was calculated and estimated. These prevalence, together with a set of disability weights for each condition, was used to calculate the YLD.

There was no single and comprehensive source of prevalence data for all non-fatal disease and injury. The prevalence of diseases and injuries were drawn from a wide variety of sources. Where possible, national data sources and local studies were used to obtain the most reliable Malaysian estimates.

Administrative data sources, including disease surveillance data, diseases registries and hospitalization data, were evaluated for their representativeness and adjusted as necessary to estimate prevalence of certain diseases. Surveys, epidemiological studies, and local studies were evaluated for their representativeness and quality before being used to estimate the prevalence.

Regional and international studies were used to produce estimates where local data was not available or deemed unreliable. Regional studies were preferred compared to studies and estimates from other regions based on the assumption that this reflected a more accurate local representation. Meta-analysis and systematic reviews, where available, were used to obtain the most accurate estimates in the absence of local and regional data.

Where disease prevalence or other parameters for estimates were not available from any reliable source, the incidence or prevalence estimates were obtained from Global Health Data Exchange GBD Results Tool from the Institute for Health Metrics and Evaluation (IHME).

DISMOD-II was used to produce prevalence estimates from incidence, case fatality, remission or duration data that was available. DISMOD-II is a freely available software commonly used for burden of disease analysis. The Malaysian population structure and background mortality

2.3.1Morbidity Data

Source


rates for each corresponding year is entered into DISMOD-II to produce these estimates.

Details of the disease models and sequelae used in this study is included in Appendix II.

Each disease consists of a conceptual model of health loss which depicts the major sources of health loss caused by different severity levels and stages of a disease. In most cases, the major sources of health loss, also called the sequelae, were based on GBD 2015.

The disability weight (DW) for each sequelae was obtained from the GBD 2015 Supplement. Where necessary or limited by data availability, composite and/or combined disability weights were used based on disability weights for 235 unique health states in the Global Burden of Disease 2013 study. Combined disability weights were calculated according to the following formula:

Years Lost due to Disability (YLD) was calculated by multiplying the prevalence of the disease sequelae to its disability weight by age group and sex. The total YLD for each disease and injury was obtained from the sum of YLD from all the sequelae of that disease.

2.3.2Severity Distribution

and Disability Weights

2.3.3Calculating Years Lost

due to Disability

CDW 1 (1-DW1) (1-DW2)COMBINED DISABILITY WEIGHT

= - ...x

YLD P DWYEARS LOST DUE TO DISABILITY = xPREVALENCE DISABILITY WEIGHT


Figure 2.1: Components of Disability-Adjusted Life Years (DALYs)

Disability-Adjusted Life Years (DALYs) represents the total burden of the diseases and injuries. The DALY for each disease and injury was calculated by summing the Years of Life Lost (YLL) and Years Lost due to Disability (YLD) for the disease or injury. The burden of disease of a disease group was calculated by summing the DALYs across all the diseases or injury in the group and the total burden of disease was calculated by summing the DALYs across all conditions.

2.4DISABILITY-

ADJUSTED LIFE YEARS

References

Harvard University, Institute for Health Metrics and Evaluation at the University of Washington, John Hopkins University, University of Queensland, World Health Organization (2009). GBD Study Operation Manual – Final Draft.

Institute for Public Health (2016). A Study on Determination of Cause of Deaths in MalaysiaSalomon JA, Haagsma JA, Davis A, de Noordhout CM, Polinder S, Havelaar AH, Cassini A, Devleesschauwer B,

Kretzschmar M, Speybroeck N, Murray CJ (2015). Disability weights for the Global Burden of Disease 2013 study. The Lancet Global Health.3(11): e712-23.

Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., ... & Coggeshall, M. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1545-1602. (Supplementary Appendix)

World Health Organization (2013). WHO methods and data sources for global burden of disease estimates 2000-2011. Geneva: Department of Health Statistics and Information Systems.

D ALY Y L D Y L L

DISABILITYADJUSTEDLIFE YEARS

YEARS LOSTDUE TODISABILITY

YEARS OFLIFE LOST

E X P ECT E DL I F E Y E A RSE A R LY D E AT H

R.I.P.

H E A LT H Y L I F E D I S E A S E O R D I SA B I L I T Y

= +


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3.0Deaths

Mortality statistics are the most basic health data of a country. Reliable cause of death is necessary for health status assessment and epidemiological research. Furthermore, especially for countries experiencing rapid health changes such as Malaysia, mortality data is essential in understanding the population health dynamics and for developing meaningful policies.


In 2009, a total of 131,328 deaths occurred in Malaysia. A total of 75,961 deaths (57.8%) occurred among males and 55,367 deaths (42.2%) among females.

3.1.1 Pattern of Deaths by sex

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PEOPLE

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CARDIOVASCULAR AND CIRCULATORY DISEASES MALIGNANT NEOPLASMS RESPIRATORY INFECTIONS

UNINTENTIONAL INJURIES RESPIRATORY DISEASES DIABETES MELLITUS

DIGESTIVE DISEASES INFECTIOUS DISEASES GENITO URINARY DISEASE

NEONATAL CONDITIONS NEUROLOGICAL CONDITIONS CONGENITAL ANOMALIES

SKIN DISEASES INTENTIONAL INJURIES ENDOCRINE, BLOOD AND IMMUNE DISORDERS

MUSCULOSKELETAL DISEASES BENIGN NEOPLASMS MATERNAL CONDITIONS

NUTRITIONAL DEFICIENCY ORAL CONDITIONS MENTAL AND BEHAVIOURAL DISORDER

SENSE ORGAN DISEASES

Figure 3.1.1: Percentage (%) of deaths, by disease groups and sex, 2009

Overall, Cardiovascular and Circulatory Diseases were the largest contributor towards deaths in Malaysia for 2009, followed by Malignant Neoplasms and Respiratory Infections [Figure 3.1.1]. For both males and females, Cardiovascular and Circulatory Diseases caused the highest number of deaths and contributed to more than a third of deaths. For males, Malignant Neoplasms contributed towards 13.9% of deaths followed by Unintentional Injuries at 12.6% and Respiratory Diseases at 9.4%. For females, Malignant Neoplasms were the second largest contributor of deaths with 16.5%, followed by Respiratory Infections at 11.7% and Diabetes Mellitus at 7.5% [Table 3.1.1].

3.1 Deaths - 2009


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umbe

r)

1457

6487 193

694

9155 220

4142 328

564

2006

340

1020

9120

83 365

299

514

2572 106

5536

7

Deat

hs (%

)

2.6

11.7 0.3 1.3 0.0

16.5 0.4 7.5 0.6

0.0 1.0 0.0

36.2 7.2 3.8

3.8

0.7

0.5

0.9

0.0

4.6

0.2

100.

0

PEOP

LEM

ALES

FEM

ALES

Colo

ur le

gend

:GR

OUP

I :

Com

mun

icab

le, M

ater

nal,

Perin

atal

and

Nut

ritio

nal C

ondi

tions

GROU

P II

: No

ncom

mun

icab

le D

isea

ses

GROU

P III

: In

jurie

s

Tabl

e 3.1

.1: D

eath

s by

dis

ease

gro

ups

and

by s

ex, 2

009


3.1.2 Pattern of Deaths by age

Among males, mortality among those below 5 years of age contributed towards 3.2% of the total deaths in Malaysia for 2009. Neonatal Conditions contributed the largest percentage, 41.8%, of the deaths among males below 5 years of age, followed by Congenital Anomalies at 18.2%. Unintentional Injuries were the predominant cause of deaths among the males 5 to 44 years of age. Cardiovascular and Circulatory Diseases were the highest contributor of deaths among males from the age of 45 years and above. Respiratory Diseases had an increasing percentage of contribution towards deaths in males as the age increases [Figure 3.1.2].

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 +

Deat

hs

Age group (years)

(a)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 +

Rela

tive

prop

ortio

n

Age group (years)

(b)

INFECTIOUS DISEASES RESPIRATORY INFECTIONS MATERNAL CONDITIONS

NEONATAL CONDITIONS NUTRITIONAL DEFICIENCY MALIGNANT NEOPLASMS

BENIGN NEOPLASMS DIABETES MELLITUS ENDOCRINE, BLOOD AND IMMUNE DISORDERS

MENTAL AND BEHAVIOURAL DISORDER NEUROLOGICAL CONDITIONS SENSE ORGAN DISEASES

CARDIOVASCULAR AND CIRCULATORY DISEASES RESPIRATORY DISEASES DIGESTIVE DISEASES

GENITO URINARY DISEASE SKIN DISEASES MUSCULOSKELETAL DISEASES

CONGENITAL ANOMALIES ORAL CONDITIONS UNINTENTIONAL INJURIES

INTENTIONAL INJURIES

Figure 3.1.2: Number (a) & percentage (b) of deaths, by disease groups & age, males, 2009


Among females, mortality among those below 5 years of age contributed towards 3.4% of the total deaths in Malaysia for 2009. Neonatal Conditions contributed the largest percentage, 36.8%, of the deaths among females below 5 years of age, followed by Congenital Anomalies at 24.0%. Unintentional Injuries were the predominant cause of deaths among the females 5 to 29 years of age, while Malignant Neoplasms were the predominant cause of deaths among females 30 to 44 years of age. Cardiovascular and Circulatory Diseases were the highest contributor of deaths among females from the age of 45 years and above, with an increasing percentage of contribution by Respiratory Infections towards deaths in females as the age increases [Figure 3.1.3].

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 +

Deat

hs

Age group (years)

(a)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 +

Rela

tive

prop

ortio

n

Age group (years)

(b)









Figure 3.1.3: Number (a) & percentage (b) of deaths, by disease groups & age, females, 2009


3.1.3 Leading Causes of Deaths

Cerebrovascular Diseases were the leading cause of deaths in Malaysia for 2009, contributing to 15.4% of the total deaths. This was followed by Ischaemic Heart Disease, with 15.2%, and Lower Respiratory Infections, with 9.5% of total deaths. Road Traffic Injuries, with 6.9% and Chronic Obstructive Pulmonary Disease with 6.4% make up the five leading causes of death in 2009.

Among males, Ischaemic Heart Disease contributed the largest amount of deaths with 16.5%. Cerebrovascular Diseases were the second highest contributor of deaths in males with 13.4% followed by Road Traffic Injuries with 10.2%. Lower Respiratory Infections and Chronic Obstructive Pulmonary Disease make up the fourth and fifth leading causes of death among males. Among females, Cerebrovascular Diseases were the leading cause of death with 18.1% followed by Ischaemic Heart Disease with 13.3% and Lower Respiratory Infections with 11.7%. Diabetes Mellitus was the fourth and Chronic Obstructive Pulmonary Disease make up the fifth leading cause of deaths among females [Table 3.1.2].

The leading causes of death vary according to age. Among males below 5 years of age, Birth Trauma and Asphyxia contributed the highest number of deaths. Road Traffic Injuries were the leading cause of deaths among males 5 to 44 years of age. Ischaemic Heart Disease was the second highest contributor of deaths among males 30 to 44 years of age. Among males of 45 to 79 years of age, Ischaemic Heart Diseases rises to the leading cause of deaths. Cerebrovascular Diseases were the second leading cause of deaths among males 45 to 79 years of age, and the leading cause of deaths among males 80 years of age and above. Chronic Obstructive Pulmonary Disease was the second highest cause of deaths among those 80 years of age and above. Leukaemia was the leading cancer causing deaths among males below 30 years of age while Trachea, Bronchus and Lung Cancers were the leading cancer causing deaths among those 30 years and above [Figure 3.1.4].

Among females below 5 years of age, Lower Respiratory Infections contributed the highest number of deaths. Road Traffic Injuries were the leading cause of deaths among females 5 to 29 years of age. Breast Cancer was found to contribute the highest number of deaths among females 30 to 44 years of age. Cerebrovascular Diseases were the second highest contributor of deaths among females 30 to 44 years of age and among females of 45 years of age and above, Cerebrovascular Diseases were the leading cause of deaths. Ischaemic Heart Disease was the second leading cause of deaths among females 45 to 79 years of age. Lower Respiratory Infections were the third leading cause of deaths among females 70 to 79 years of age and the second highest cause of deaths among those 80 years of age and above. Breast cancer was the leading cancer causing deaths among females 30 to 69 years of age. Trachea, Bronchus and Lung Cancers were the leading cancer causing deaths among those 70 years and above [Figure 3.1.5].


Rank

Peop

leDe

aths

1Ce

rebr

ovas

cula

r Dis

ease

s (S

trok

e)10

037

2Is

chae

mic

Hea

rt D

isea

se73

68

3Lo

wer

Res

pira

tory

Infe

ctio

ns64

81

4Ro

ad T

raffi

c In

jurie

s41

42

5Ch

roni

c Ob

stru

ctiv

e Pu

lmon

ary

Dise

ase

2471

6Di

abet

es M

ellit

us18

79

7Tr

ache

a, B

ronc

hus

and

Lung

Can

cers

1379

8Ne

phrit

is a

nd N

ephr

osis

1341

9Co

lon

and

Rect

um C

ance

rs12

63

10Br

east

Can

cer

1049

11Tu

berc

ulos

is82

0

12Li

ver C

ance

rs72

7

13Fa

lls62

8

14Hy

pert

ensi

ve D

isea

se62

5

15As

thm

a56

9

16HI

V45

8

17Le

ukae

mia

365

18Sk

in a

nd s

ubcu

tane

ous

dise

ases

365

19St

omac

h Ca

ncer

333

20M

outh

and

Oro

phar

ynx

Canc

ers

328

Top

20 d

isea

ses

4740

9

All o

ther

dis

ease

s79

58

Tota

l

Deat

hs

2020

0

1990

4

1250

8

9104

8357

7701

3978

2807

2461

1977

1665

1654

1498

1440

1255

1139 969

936

848

825

1102

24

2110

4

1313

28

% o

f to

tal

15.4

15.2 9.5

6.9

6.4

5.9

3.0 2.1

1.9 1.5 1.3 1.3 1.1 1.1 1.0 0.9

0.7

0.7

0.6

0.6

83.9

16.1

100.

0

Mal

es

Isch

aem

ic H

eart

Dis

ease

Cere

brov

ascu

lar D

isea

ses

(St r

oke)

Road

Tra

ffic

Inju

ries

Low

er R

espi

rato

ry In

fect

ions

Chro

nic

Obst

ruct

ive

Pulm

onar

y Di

seas

e

Diab

etes

Mel

litus

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs

Neph

ritis

and

Nep

hros

is

Colo

n an

d Re

ctum

Can

cers

Tube

rcul

osis

Live

r Can

cers

HIV

Hype

rten

sive

Dis

ease

Falls

Leuk

aem

ia

Othe

r Urin

ary

Dise

ases

Mou

th a

nd O

roph

aryn

x Ca

ncer

s

Skin

and

sub

cuta

neou

s di

seas

es

Pros

tate

Can

cer

Pept

ic U

lcer

Dis

ease

Top

20 d

isea

ses

All o

ther

dis

ease

s

Tota

l

Deat

hs

1253

6

1016

3

7725

6027

5886

3559

2715

1466

1412

1207

1085

1011 812

771

662

606

595

571

517

487

6421

1

1175

0

7596

1

% o

f to

tal

16.5

13.4

10.2 7.9 7.7

4.7

3.6 1.9 1.9 1.6 1.4 1.3 1.1 1.0 0.9

0.8

0.8

0.8 0.7

0.6

84.5

15.5

100.

0

Fem

ales

Cere

brov

ascu

lar D

isea

ses

(Str

oke)

Isch

aem

ic H

eart

Dis

ease

Low

er R

espi

rato

ry In

fect

ions

Diab

etes

Mel

litus

Chro

nic

Obst

ruct

ive

Pulm

onar

y Di

seas

e

Brea

st C

ance

r

Road

Tra

ffic

Inju

ries

Neph

ritis

and

Nep

hros

is

Trac

hea,

Bro

nch u

s an

d Lu

ng C

ance

rs

Colo

n an

d Re

ctum

Can

cers

Asth

ma

Falls

Hype

rten

sive

Dis

ease

Cerv

ix C

ance

r

Live

r Can

cers

Tube

rcul

osis

Stom

ach

Canc

er

Skin

and

sub

cuta

neou

s di

seas

es

Brai

n an

d Ot

her C

NS C

ance

rs

Endo

crin

e, B

lood

and

Imm

une

Diso

rder

s

Top

20 d

isea

ses

All o

ther

dis

ease

s

Tota

l55

367

% o

f to

tal

18.1

13.3

11.7 7.5 4.5

3.4

2.5

2.4

2.3

1.9 1.5 1.3 1.1 1.1 1.0 0.8 0.7

0.7

0.6

0.6

85.6

14.4

100.

0

Colo

ur le

gend

:

>5%

4-5

%3

-4%

2-3

%0

-2%

Tabl

e 3.1

.2: L

eadi

ng c

ause

s of

dea

ths,

by

sex,

200

9


Rank

0 - 4

5 - 1

415

- 29

30 -

4445

- 59

60 -

6970

- 79

80 +

1st

Birt

h Tr

aum

a an

d As

phyx

ia

(0.2

5; 1

0.5%

)

Road

Tra

ffic

Inju

ries

(0.2

8; 2

9.7%

)Ro

ad T

raffi

c In

jurie

s(3

.01;

60.4

%)

Road

Tra

ffic

Inju

ries

(1.5

0;0

19.3

%)

Isch

aem

ic H

eart

Dis

ease

(3.8

0; 2

3.1%

)Is

chae

mic

Hea

rt D

isea

se(3

.25;

21.0

%)

Isch

aem

ic H

eart

Dis

ease

(2.8

4; 1

7.1%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(2.0

9; 1

8.3%

)

2nd

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.24;

9.9

%)

Leuk

aem

ia(0

.08;

8.3

%)

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.18; 3

.7%)

Isch

aem

ic H

eart

Dis

ease

(0.9

7; 12

.5%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(2.0

1; 12

.2%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(2.5

6; 1

6.5%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(2.8

3; 1

7.0%

)

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e(2

.04;

17.9

%)

3rd

Low

Birt

h W

eigh

t(0

.22;

9.2

%)

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.06;

6.8

%)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(0.13

; 2.5

%)

HIV

(0.70

; 9.0

%)

Road

Tra

ffic

Inju

ries

(1.2

3; 7

.5%

)

Low

er R

espi

rato

ry

Infe

ctio

ns(1

.04;

6.7%

)

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e(2

.43;

14.

6%)

Low

er R

espi

rato

ry

Infe

ctio

ns(1

.78; 1

5.7%

)

4th

Neon

atal

Infe

ctio

ns(0

.15; 6

.4%

)Dr

owni

ng(0

.06;

6.8

%)

Leuk

aem

ia(0

.11; 2

.2%

)

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.56;

7.2

%)

Diab

etes

Mel

litus

(1.10

; 6.7%

)

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e(1

.01;

6.5%

)

Low

er R

espi

rato

ry

Infe

ctio

ns(1

.30;

7.8

%)

Isch

aem

ic H

eart

Dis

ease

(1.6

; 14.

0%)

5th

Cong

enita

l Hea

rt

Dise

ases

(0.15

; 6.1%

)

Brai

n an

d O

ther

CNS

Ca

ncer

s(0

.04;

4.3

%)

HIV

(0.0

9; 1

.8%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(0.5

0; 6

.5%

)

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.86;

5.2

%)

Diab

etes

Mel

litus

(0.9

1; 5.

9%)

Diab

etes

Mel

litus

(0.79

; 4.8

%)

Diab

etes

Mel

litus

(0.4

7; 4.

1%)

6th

Road

Tra

ffic

Inju

ries

(0.0

9; 3

.8%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(0.0

4; 3

.9%

)

Self-

Infli

cted

Inju

ries

(0.0

9; 1

.7%)

Tube

rcul

osis

(0.3

3; 4

.3%

)

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs(0

.63;

3.8

%)

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs(0

.88;

5.7%

)

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs(0

.71; 4

.3%

)

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs(0

.37;

3.2%

)

7th

Diar

rhoe

al D

isea

ses

(0.0

9; 3

.6%

)Di

arrh

oeal

Dis

ease

s(0

.04;

3.8

%)

Isch

aem

ic H

eart

Dis

ease

(0.0

8; 1

.6%

)Di

abet

es M

ellit

us(0

.24;

3.1%

)Li

ver C

ance

rs(0

.39;

2.4

%)

Road

Tra

ffic

Inju

ri es

(0.71

; 4.6

%)

Road

Tra

ffic

Inju

ries

(0.6

7; 4.

1%)

Colo

n an

d Re

ctum

Ca

ncer

s(0

.25;

2.2

%)

8th

Leuk

aem

ia(0

.06;

2.4

%)

Men

ingi

tis(0

.02;

2.5

%)

Tube

rcul

osis

(0.0

8; 1

.6%

)Hy

pert

ensi

ve D

isea

se(0

.17; 2

.2%

)Ne

phrit

is a

nd N

ephr

osis

(0.3

8; 2

.3%

)

Colo

n an

d Re

ctum

Ca

ncer

s(0

.42;

2.7%

)

Neph

ritis

and

Nep

hros

is(0

.35;

2.1%

)Ro

ad T

raffi

c In

jurie

s(0

.23;

2%

)

9th

Anen

ceph

aly

(0.0

6; 2

.3%

)Rh

eum

atic

Hea

rt D

isea

se(0

.02;

2.4

%)

Drow

ning

(0.0

7; 1.5

%)

Falls

(0.13

; 1.7%

)

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e(0

.37;

2.2%

)

Neph

ritis

and

Nep

hros

is(0

.41;

2.6%

)

Colo

n an

d Re

ctum

Ca

ncer

s(0

.35;

2.1%

)

Neph

ritis

and

Nep

hros

is(0

.18; 1

.6%

)

10th

Men

ingi

tis(0

.04;

1.6

%)

Epile

psy

(0.0

2; 1

.6%

)Fa

lls(0

.07;

1.4%

)

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs(0

.11; 1

.4%

)

Tube

rcul

osis

(0.3

3; 2

%)

Live

r Can

cers

(0.3

3; 2

.2%

)Ly

mph

oma

(0.3

; 1.8

%)

Skin

and

sub

cuta

neou

s di

seas

es(0

.18; 1

.6%

)

Age

grou

p (y

ears

)

Figu

re 3

.1.4:

Lea

ding

cau

ses

of d

eath

(dea

th ‘0

00; p

erce

ntag

e %

) for

mal

es, b

y ag

e gr

oup,

200

9


Rank

0 - 4

5 - 1

415

- 29

30 -

4445

- 59

60 -

6970

- 79

80 +

1st

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.19; 1

0.0%

)

Road

Tra

ffic

Inju

ries

(0.0

9; 1

6.5%

)Ro

ad T

raffi

c In

jurie

s(0

.47;

27.6

%)

Brea

st C

ance

r(0

.31;

9.9%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(1.15

; 13.

2%)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(1.9

1; 20

.0%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(3.12

; 21.4

%)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(3.4

9; 2

2.9%

)

2nd

Low

Birt

h W

eigh

t(0

.15; 8

.1%)

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.07;

12.7%

)

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.12; 6

.8%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(0.2

7; 8.

8%)

Isch

aem

ic H

eart

Dis

ease

(1.10

; 12.

5%)

Isch

aem

ic H

eart

Dis

ease

(1.4

0; 1

4.7%

)Is

chae

mic

Hea

rt D

isea

se(2

.58;

17.7

%)

Low

er R

espi

rato

ry

Infe

ctio

ns(3

.08;

20.

2%)

3rd

Birt

h Tr

aum

a an

d As

phyx

ia

(0.15

; 8.1%

)

Brai

n an

d O

ther

CNS

Ca

ncer

s(0

.04;

7.1%

)

Diab

etes

Mel

litus

(0.0

6; 3

.3%

)

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.25;

7.9

%)

Diab

etes

Mel

litus

(0.8

6; 9

.8%

)Di

abet

es M

ellit

us(1

.01;

10.6

%)

Low

er R

espi

rato

ry

Infe

ctio

ns(1

.65;

11.3

%)

Isch

aem

ic H

eart

Dis

ease

(2.0

9; 1

3.7%

)

4th

Neon

atal

Infe

ctio

ns(0

.13; 7

.1%)

Leuk

aem

ia(0

.03;

5.8

%)

Tube

rcul

osis

(0.0

6; 3

.3%

)Ro

ad T

raffi

c In

jurie

s(0

.2; 6

.5%

)Br

east

Can

cer

(0.8

1; 9.

2%)

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.63;

6.6

%)

Diab

etes

Mel

litus

(1.0

8; 7

.4%

)

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e(1

.30;

8.5

%)

5th

Cong

enita

l Hea

rt

Dise

ases

(0.13

; 7.1%

)

Drow

ning

(0.0

2; 4

.2%

)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(0.0

5; 3

.1%)

Diab

etes

Mel

litus

(0.19

; 6.1%

)

Low

er R

espi

rato

ry

Infe

ctio

ns(0

.51;

5.8%

)

Brea

st C

ance

r(0

.40;

4.2

%)

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e(0

.88;

6.0

%)

Diab

etes

Mel

litus

(0.9

3; 6

.1%)

6th

Diar

rhoe

al D

isea

ses

(0.10

; 5.3

%)

Cere

brov

ascu

lar

Dise

ases

(Str

oke)

(0.0

2; 4

.1%)

Leuk

aem

ia(0

.05;

3%

)Is

chae

mic

Hea

rt D

isea

se(0

.19; 6

%)

Neph

ritis

and

Nep

hros

is(0

.28;

3.2

%)

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs(0

.32;

3.4

%)

Neph

ritis

and

Nep

hros

is(0

.39;

2.7%

)As

thm

a(0

.49;

3.2

%)

7th

Road

Tra

ffic

Inju

ries

(0.0

6; 3

.0%

)Ep

ileps

y(0

.01;

2.3%

)

Brai

n an

d O

ther

CNS

Ca

ncer

s(0

.04;

2.5

%)

Hype

rten

sive

Dis

ease

(0.11

; 3.6

%)

Road

Tra

ffic

Inju

ries

(0.2

5; 2

.8%

)

Colo

n an

d Re

ctum

Ca

ncer

s(0

.26;

2.7%

)

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs(0

.39;

2.7%

)

N eph

ritis

and

Nep

hros

is(0

.29;

1.9

%)

8th

Anen

ceph

aly

(0.0

4; 2

.3%

)

Endo

crin

e, B

lood

and

Im

mun

e Di

sord

ers

(0.0

1; 2.

1%)

Falls

(0.0

4; 2

.2%

)Ne

phrit

is a

nd N

ephr

osis

(0.0

8; 2

.7%)

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs(0

.23;

2.7%

)

Neph

ritis

and

Nep

hros

is(0

.25;

2.6

%)

Colo

n an

d Re

ctum

Ca

ncer

s(0

.35;

2.4

%)

Trac

hea,

Bro

nchu

s an

d Lu

ng C

ance

rs(0

.25;

1.6

%)

9th

Fire

s, H

eat a

nd H

ot

Subs

tanc

es(0

.03;

1.6

%)

Diab

etes

Mel

litus

(0.0

1; 1.9

%)

Neph

ritis

and

Nep

hros

is(0

.03;

1.8

%)

Falls

(0.0

8; 2

.6%

)

Colo

n an

d Re

ctum

Ca

ncer

s(0

.2; 2

.3%

)

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e(0

.22;

2.3

%)

Falls

(0.2

6; 1

.8%

)Hy

pert

ensi

ve D

isea

se(0

.19; 1

.3%

)

10th

Men

ingi

tis(0

.02;

1.1%

)Be

nign

Neo

plas

ms

(0.0

1; 1.8

%)

HIV

(0.0

3; 1

.6%

)Tu

berc

ulos

is(0

.08;

2.5

%)

Cerv

ix C

ance

r(0

.20;

2.2

%)

Road

Tra

ffic

Inju

ries

(0.16

; 1.6

%)

Live

r Can

cers

(0.2

0; 1

.4%

)

Colo

n an

d Re

ctum

Ca

ncer

s(0

.19; 1

.2%

)

Age

grou

p (y

ears

)

Figu

re 3

.1.5:

Lea

ding

cau

ses

of d

eath

(dea

th ‘0

00; p

erce

ntag

e %

) for

fem

ales

, by

age

grou

p, 2

009


In 2010, a total of 130,978 deaths occurred in Malaysia. A total of 75,905 deaths (58.0%) occurred among males and 55,073 deaths (42.0%) among females.

3.2.1 Pattern of Deaths by sex

35.6

34.3

37.4

15.1

14.4

16.2

9.1

12.3

4.8

8.7

7.4

10.5

8.6

10.0

6.6

5.8

4.8

7.1

PEOPLE

MALES

FEMALES

CARDIOVASCULAR AND CIRCULATORY DISEASES MALIGNANT NEOPLASMS UNINTENTIONAL INJURIES

RESPIRATORY INFECTIONS RESPIRATORY DISEASES DIABETES MELLITUS

DIGESTIVE DISEASES INFECTIOUS DISEASES GENITO URINARY DISEASE

NEONATAL CONDITIONS NEUROLOGICAL CONDITIONS SKIN DISEASES

CONGENITAL ANOMALIES ENDOCRINE, BLOOD AND IMMUNE DISORDERS INTENTIONAL INJURIES

MUSCULOSKELETAL DISEASES BENIGN NEOPLASMS MATERNAL CONDITIONS

MENTAL AND BEHAVIOURAL DISORDER ORAL CONDITIONS NUTRITIONAL DEFICIENCY

SENSE ORGAN DISEASES

Figure 3.2.1: Percentage (%) of deaths, by disease groups and sex, 2010

Overall, Cardiovascular and Circulatory Diseases were the largest contributor towards deaths in Malaysia for 2010, followed by Malignant Neoplasms and Unintentional Injuries [Figure 3.2.1]. For both males and females, Cardiovascular and Circulatory Diseases caused the highest number of deaths and contributed to more than a third of deaths. For males, Malignant Neoplasms contributed towards 14.4% of deaths followed by Unintentional Injuries at 12.3% and Respiratory Diseases at 10.0%. For females, Malignant Neoplasms were the second largest contributor of deaths with 16.2%, followed by Respiratory Infections at 10.5% and Diabetes Mellitus at 7.1% [Table 3.2.1].

3.2 Deaths - 2010


DISE

ASE

GROU

PIN

FECT

IOUS

DIS

EASE

S

RESP

IRAT

ORY

INFE

CTIO

NS

MAT

ERNA

L CO

NDIT

IONS

NEO

NATA

L CO

NDIT

IONS

NU

TRIT

IONA

L DE

FICI

ENCY

20

MAL

IGNA

NT N

EOPL

ASM

S

BENI

GN N

EOPL

ASM

S

DIAB

ETES

MEL

LITU

S

ENDO

CRIN

E, B

LOO

D AN

D IM

MUN

E DI

SORD

ERS

M

ENTA

L AN

D BE

HAVI

OUR

AL D

ISO

RDER

82

NEUR

OLO

GICA

L CO

NDIT

IONS

SE

NSE

ORG

AN D

ISEA

SES

4

CARD

IOVA

SCUL

AR A

ND C

IRCU

LATO

RY D

ISEA

SES

RESP

IRAT

ORY

DIS

EASE

S

DIGE

STIV

E DI

SEAS

ES

GENI

TO U

RINA

RY D

ISEA

SE

SKIN

DIS

EASE

S

MUS

CULO

SKEL

ETAL

DIS

EASE

S

CONG

ENIT

AL A

NOM

ALIE

S

ORA

L CO

NDIT

IONS

29

UNIN

TENT

IONA

L IN

JURI

ES

INTE

NTIO

NAL

INJU

RIES

TO

TAL

Deat

hs (n

umbe

r)

4836

1136

018

616

51

1982

039

175

42 687

1464

4661

111

205

5180

4566

1089 64

798

5

1196

066

313

0978

Deat

hs (%

)

3.7

8.7

0.1

1.3 0.0

15.1 0.3

5.8

0.5

0.1 1.1 0.0

35.6 8.6

4.0 3.5

0.8

0.5

0.8

0.0 9.1

0.5

100.

0

0 1

Deat

hs (n

umbe

r)

3345

5599 98

5 1010

894

167

3609 33

5 79 887

2603

775

6929

5821

71 511

310

484 27

9342 585

7590

5

Deat

hs (%

)

4.4 7.4 0.0 1.3 0.0

14.4 0.2

4.8

0.4

0.1

1.2 0.0

34.3

10.0 3.9

2.9

0.7

0.4

0.6

0.0

12.3 0.8

100.

0

Deat

hs (n

umbe

r)

1491

5761 186

666 10

8926 224

3933 352 3

577 3

2057

436

3622

2223

95 578

337

501 2

2618 78

5507

3

Deat

hs (%

)

2.7

10.5 0.3 1.2 0.0

16.2 0.4 7.1 0.6

0.0 1.0 0.0

37.4 6.6

4.0

4.3

1.0 0.6

0.9

0.0

4.8 0.1

100.

0

PEOP

LEM

ALES

FEM

ALES

Colo

ur le

gend

:GR

OUP

I :

Com

mun

icab

le, M

ater

nal,

Perin

atal

and

Nut

ritio

nal C

ondi

tions

GROU

P II

: No

ncom

mun

icab

le D

isea

ses

GROU

P III

: In

jurie

s

Tabl

e 3.

2.1: D

eath

s by

dis

ease

gro

ups

and

by s

ex, 2

010


3.2.2 Pattern of Deaths by age

Among males, mortality among those below 5 years of age contributed towards 3.0% of the total deaths in Malaysia for 2010. Neonatal Conditions contributed the largest percentage, 42.5%, of the deaths among males below 5 years of age, followed by Congenital Anomalies at 18.0%. Unintentional Injuries were the predominant cause of deaths among the males 5 to 29 years of age. Cardiovascular and Circulatory Diseases were the highest contributor of deaths among males from the age of 30 years and above. Respiratory Diseases had an increasing percentage of contribution towards deaths in males as the age increases [Figure 3.2.2].

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 +

Deat

hs

Age group (years)

(a)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 +

Rela

tive

prop

ortio

n

Age group (years)

(b)









Figure 3.2.2: Number (a) & percentage (b) of deaths, by disease groups & age, males, 2010


Among females, mortality among those below 5 years of age contributed towards 3.3% of the total deaths in Malaysia for 2010. Neonatal Conditions contributed the largest percentage, 37.1%, of the deaths among females below 5 years of age, followed by Congenital Anomalies at 24.5%. Unintentional Injuries were the predominant cause of deaths among the females 5 to 29 years of age, while Malignant Neoplasms were the predominant cause of deaths among females 30 to 59 years of age. Cardiovascular and Circulatory Diseases were the highest contributor of deaths among females from the age of 60 years and above, with an increasing percentage of contribution by Respiratory Infections towards deaths in females as the age increases [Figure 3.2.3].

0

2000

4000

6000

8000

10000

12000

14000

16000

0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 +

Deat

hs

Age group (years)

(a)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 - 4 5 - 14 15 - 29 30 - 44 45 - 59 60 - 69 70 - 79 80 +

Rela

tive

prop

ortio

n

Age group (years)

(b)









Figure 3.2.3: Number (a) & percentage (b) of deaths, by disease groups & age, females, 2010


3.2.3 Leading Causes of Deaths

Ischaemic Heart Disease were the leading cause of deaths in Malaysia for 2010, contributing to 15.4% of the total deaths. This was followed by Cerebrovascular Diseases, with 15.4%, and Lower Respiratory Infections, with 8.7% of total deaths. Road Traffic Injuries, with 6.8% and Chronic Obstructive Pulmonary Disease with 6.4% make up the five leading causes of death in 2010.

Among males, Ischaemic Heart Disease contributed the largest amount of deaths with 16.6%. Cerebrovascular Diseases were the second highest contributor of deaths in males with 13.4% followed by Road Traffic Injuries with 9.8%. Chronic Obstructive Pulmonary Disease and Lower Respiratory Infections and make up the fourth and fifth leading causes of death among males. Among females, Cerebrovascular Diseases were the leading cause of death with 18.1% followed by Ischaemic Heart Disease with 13.9% and Lower Respiratory Infections with 10.5%. Diabetes Mellitus was the fourth a

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